Vaginal cysts

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A 1906 illustration of a Gartner cyst on the vaginal wall Operative gynecology - (1906) (14781201664).jpg
A 1906 illustration of a Gartner cyst on the vaginal wall

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. [1] [2] The type of epithelial tissue lining a cyst is used to classify these growths. [3] They can be congenital. [4] [5] [6] [7] They can present in childhood and adulthood. [7] The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. [7] [8] In most instances they do not cause symptoms and present with few or no complications. [8] [4] A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. [8] [9] [10] [3] Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. [1] [11] Some cysts can be distinguished visually but most will need a biopsy to determine the type. [8] [12] Vaginal cysts can vary in size and can grow as large as 7 cm. [1] [13] Other cysts can be present on the vaginal wall though mostly these can be differentiated. [8] [14] Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. [15] The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. [1] [10] Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. [1] Growths that originate from the urethra and other tissue can present as cysts of the vagina. [16]

Contents

Types

Vaginal inclusion cysts can appear as small bumps and can develop during childbirth, or after surgery. [8] A squamous inclusion cyst can rarely be found in a newborn. [7] Other cysts can be Bartholin's cysts, Gartner's duct cysts, mucous inclusions, epithelial inclusion cysts, embryonic cysts and urothelial cysts. [1] [17] Less common vaginal cysts are endometrial cysts and vaginitis emphysematosa. Vaginitis emphysematosum is a group of gas-filled cysts on the vaginal wall; these are benign and self-limiting (resolve on their own). [16] [17] [7] Vaginal cysts can also be congenital and associated with urinary system anomalies [18] [19] [20]

The most common type of vaginal cyst are Müllerian cysts. These usually develop on the anterolateral vaginal wall. [1] This cyst can be lined with epithelium from the cervix, uterus and fallopian tubes. [21]

An epithelial inclusion cyst is also referred to as epidermal inclusion cyst or squamous inclusion cyst. [22] [10] This type of cyst comprises 23% of all vaginal cysts and is the second most common. This cyst originates from epithelium tissue that has been 'trapped' from surgery, episiotomy, or other trauma. It is most often found on the lower posterior vaginal wall. [22] [2] An epidermoid cyst is one type of vaginal cyst. [23] Inclusion cysts are small and located on the posterior, lower end of the vagina. Small pieces of vaginal epithelium are trapped beneath the surface due to perineal lacerations and imperfect surgical repair after an episiotomy. [3]

A Gartner's duct cyst develops from a small tissue remnant of the mesonephric duct. Symptoms include: infection, bladder dysfunction, abdominal pain, vaginal discharge, and urinary incontinence. [11] It is often large enough to cause urinary incontinence but surgical removal provides treatment and recurrence is unlikely. [20] [4] Diagnosis is confirmed with ultrasound imaging. [19] The evaluation by biopsy provides the most accurate diagnosis. [19] This cyst has a lining of epithelial tissue that varies from squamous to mucin-secreting transitional epithelium. [21]

Occasionally, a parasitic infection causes a vaginal cyst. [15]

Signs and symptoms

In most instances, symptoms are minimal or absent. Some women may experience vaginal pressure, discomfort, swelling, painful sex, or bleeding. [10] Cysts can also be sensitive and tender to the touch. [17]

Diagnosis

Diagnosis is aided by the use of ultrasound, CT scan, voiding cystourethrogram, and MRI. [10] [24] Ultrasound findings may be the visualization of smooth margins of a fluid-filled structure. [15] Vaginal cysts resemble other structures that protrude from the vagina such as rectocele and cystocele. Histological assessment is needed to determine the specific type of cyst. [1] Vaginal cysts are often discovered during a routine pelvic exam or pap smear. [10] [9] Cysts are also discovered during a bimanual exam. [15] Other structures that resemble vaginal cysts are connective tissue tumors, hematocolpos, and hymenal atresia. [15] The absence of vaginal rugae over the cyst is a clue to their presence. [3]

Treatment

Many cysts remain small, are followed closely by a clinician, and resolve on their own. [8] Surgery and/or drainage is performed to remove the cyst. [10] Treatment continues after the surgical removal by scheduled followups with the medical provider who looks for changes in the cyst. [8] Bartholin gland cysts often need to be drained. Sometimes, antibiotics are prescribed to treat them as well. [11] Treatment for these usually includes aspiration, marsupialisation and deroofing. [19] [13] [11] When cysts are treated complications are few. Vaginal cysts rarely recur. When surgically removed, the cysts usually do not return. In some cases a Bartholin cyst can develop and need further treatment. [8] In most cases, there are no complications from the cysts themselves. A surgical removal carries a small risk of complication. The risk depends on where the cyst is located.

See also

Related Research Articles

<span class="mw-page-title-main">Vagina</span> Part of the female reproductive tract

In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

<span class="mw-page-title-main">Bartholin's gland</span> Mucous glands located near the vaginal opening

The Bartholin's glands are two pea-sized compound alveolar glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina.

<span class="mw-page-title-main">Cyst</span> Closed sac growth on the body

A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.

<span class="mw-page-title-main">Episiotomy</span> Surgical incision of the perineum and the posterior vaginal wall

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

<span class="mw-page-title-main">Bartholin's cyst</span> Medical condition

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked. Small cysts may result in minimal or no symptoms. Larger cysts may result in swelling on one side of the vaginal opening, as well as pain during sex or walking. If the cyst becomes infected, an abscess can occur, which is typically red and very painful. If there are no symptoms, no treatment is needed. Bartholin's cysts affect about 2% of women at some point in their life. They most commonly occur during childbearing years.

<span class="mw-page-title-main">Dermoid cyst</span> Medical condition

A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair, pockets of sebum, blood, fat, bone, nail, teeth, eyes, cartilage, and thyroid tissue.

<span class="mw-page-title-main">Epidermoid cyst</span> Benign cyst usually found on the skin

An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.

<span class="mw-page-title-main">Cystocele</span> Medical condition

The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.

Hematocolpos is a medical condition in which the vagina is pooled with menstrual blood due to multiple factors leading to the blockage of menstrual blood flow. The medical definition of hematocolpos is 'an accumulation of blood within the vagina'. It is often caused by the combination of menstruation with an imperforate hymen. It is sometimes seen in Robinow syndrome, uterus didelphys, or other vaginal anomalies.

Vaginal cancer is an extraordinarily rare form of cancer that develops in the tissue of the vagina. Primary vaginal cancer originates from the vaginal tissue – most frequently squamous cell carcinoma, but primary vaginal adenocarcinoma, sarcoma, and melanoma have also been reported – while secondary vaginal cancer involves the metastasis of a cancer that originated in a different part of the body. Secondary vaginal cancer is more common. Signs of vaginal cancer may include abnormal vaginal bleeding, dysuria, tenesmus, or pelvic pain, though as many as 20% of women diagnosed with vaginal cancer are asymptomatic at the time of diagnosis. Vaginal cancer occurs more frequently in women over age 50, and the mean age of diagnosis of vaginal cancer is 60 years. It often can be cured if found and treated in early stages. Surgery alone or surgery combined with pelvic radiation is typically used to treat vaginal cancer.

<span class="mw-page-title-main">Gartner's duct cyst</span> Medical condition

A Gartner's duct cyst is a benign vaginal cyst that originates from the Gartner's duct, which is a vestigial remnant of the mesonephric duct in females. Persistent Wolffian duct syndrome (PWDS) in individuals with XX chromosomes is the inverse disorder of Persistent Müllerian duct syndrome (PMDS) in individuals with XY chromosomes. They are typically small asymptomatic cysts that occur along the lateral walls of the vagina, following the course of the duct. They can present in adolescence with painful menstruation (dysmenorrhea) or difficulty inserting a tampon. They can also enlarge to substantial proportions and be mistaken for urethral diverticulum or cystocele. In some rare instances, they can be congenital.

A urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers (fascia) that surround it.

<span class="mw-page-title-main">Bartholin gland carcinoma</span> Medical condition

Bartholin gland carcinoma is a type of cancer of the vulva arising in the Bartholin gland. It typically presents with a painless mass at one side of the vaginal opening in a female of middle-age and older, and can appear similar to a Bartholin cyst. The mass may be big or small, may be deep under skin or appear nearer the surface with overlying ulceration. Average age at presentation is 53-years.

A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. Urogenital fistulas vary in etiology. Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas.

<span class="mw-page-title-main">Vaginal epithelium</span> Inner lining of the vagina

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers of cells. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

Vaginal rugae are structures of the vagina that are transverse ridges formed out of the supporting tissues and vaginal epithelium in females. Some conditions can cause the disappearance of vaginal rugae and are usually associated with childbirth and prolapse of pelvic structures. The rugae contribute to the resiliency and elasticity of the vagina and its ability to distend and return to its previous state. These structures not only allow expansions and an increase in surface area of the vaginal epithelium, they provide the space necessary for the vaginal microbiota. The shape and structure of the rugae are supported and maintained by the lamina propria of the vagina and the anterior and posterior rugae.

Vulvar tumors are those neoplasms of the vulva. Vulvar and vaginal neoplasms make up a small percentage (3%) of female genital cancers. They can be benign or malignant. Vulvar neoplasms are divided into cystic or solid lesions and other mixed types. Vulvar cancers are those malignant neoplasms that originate from vulvar epithelium, while vulvar sarcomas develop from non-epithelial cells such as bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Epithelial and mesenchymal tissue are the origin of vulvar tumors.

Vaginal stenosis is an abnormal condition in which the vagina becomes narrower and shorter due to the formation of fibrous tissue. Vaginal stenosis can contribute to sexual dysfunction, dyspareunia and make pelvic exams difficult and painful. The lining of the vagina may also be thinner and drier and contain scar tissue. This condition can result in pain during sexual intercourse or a pelvic exam. Vaginal stenosis is often caused by radiation therapy to the pelvis, an episiotomy, or other forms of surgical procedures. Chemotherapy can also increase the likelihood of developing vaginal stenosis. Vaginal stenosis can also result from genital reconstructive surgery in people with congenital adrenal hyperplasia.

<span class="mw-page-title-main">Ovarian squamous cell carcinoma</span> Medical condition

Ovarian squamous cell carcinoma (oSCC) or squamous ovarian carcinoma (SOC) is a rare tumor that accounts for 1% of ovarian cancers. Included in the World Health Organization's classification of ovarian cancer, it mainly affects women above 45 years of age. Survival depends on how advanced the disease is and how different or similar the individual cancer cells are.

References

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  5. ↑ Shimizu, Masaki; Imai, Toshihiro (2013). "Vaginal Cyst in a Newborn". The Journal of Pediatrics. 163 (6): 1790. doi: 10.1016/j.jpeds.2013.07.043 . PMID   24018015.
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  12. ↑ Nelson, Philippa (2018-01-23). "Endometriosis presenting as a vaginal mass". BMJ Case Reports. 2018: bcr–2017–222431. doi:10.1136/bcr-2017-222431. ISSN   1757-790X. PMC   5786902 . PMID   29367370.
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  14. ↑ Kondi-Pafiti A, Grapsa D, Papakonstantinou K, Kairi-Vassilatou E, Xasiakos D (2008). "Vaginal cysts: a common pathologic entity revisited". Clinical and Experimental Obstetrics & Gynecology. 35 (1): 41–4. PMID   18390079.
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  24. ↑ Kruger, Petrus Frans; Rahmani, Rose; Kung, Rose (2015). "2077416 Skene's Gland Duct Cysts: the Utility of Vaginal/Transperineal Imaging In Diagnosis And Mapping For Surgery. a Case Series And Review of The Literature". Ultrasound in Medicine & Biology. 41 (4): S119–S120. doi: 10.1016/j.ultrasmedbio.2014.12.479 .
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